High-fidelity simulation versus case-based discussion for teaching medical students in Brazil about pediatric emergencies

OBJECTIVE: To compare high-fidelity simulation with case-based discussion for teaching medical students about pediatric emergencies, as assessed by a knowledge post-test, a knowledge retention test and a survey of satisfaction with the method. METHODS: This was a non-randomized controlled study using a crossover design for the methods, as well as multiple-choice questionnaire tests and a satisfaction survey. Final-year medical students were allocated into two groups: group 1 participated in an anaphylaxis simulation and a discussion of a supraventricular tachycardia case, and conversely, group 2 participated in a discussion of an anaphylaxis case and a supraventricular tachycardia simulation. Students were tested on each theme at the end of their rotation (post-test) and 4-6 months later (retention test). RESULTS: Most students (108, or 66.3%) completed all of the tests. The mean scores for simulation versus case-based discussion were respectively 43.6% versus 46.6% for the anaphylaxis pre-test (p=0.42), 63.5% versus 67.8% for the post-test (p=0.13) and 61.5% versus 65.5% for the retention test (p=0.19). Additionally, the mean scores were respectively 33.9% versus 31.6% for the supraventricular tachycardia pre-test (p=0.44), 42.5% versus 47.7% for the post-test (p=0.09) and 41.5% versus 39.5% for the retention test (p=0.47). For both themes, there was improvement between the pre-test and the post-test (p;0.05). Moreover, the satisfaction survey revealed a preference for simulation (

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19

Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital

Objective: To describe the characteristics of children and adolescentes with chronic diseases of outpatient clinics at a tertiary university hospital. Methods: A cross‐sectional study was performed with 16,237 patients with chronic diseases followed‐up in one year. The data were collected through the electronic system, according to the number of physician appointments in 23 pediatric specialties. Patients were divided in two groups: children (0–9 years) and adolescents (10–19 years). Early (10–14 years) and late (15–19 years) adolescent groups were also analyzed. Results: Of the total sample, 56% were children and 46% were adolescents. The frequencies of following pediatric specialties were significantly higher in adolescents when compared with children: cardiology, endocrinology, hematology, nephrology/renal transplantation, neurology, nutrology, oncology, palliative and pain care, psychiatry, and rheumatology (p < 0.05). The frequencies of emergency service visits (30% vs. 17%, p < 0.001), hospitalizations (23% vs. 11%, p < 0.001), intensive care unit admissions (6% vs. 2%, p < 0.001), and deaths (1% vs. 0.6%, p = 0.002) were significantly lower in adolescents than in children. However, the number of physician appointments (≥13) per patient was also higher in the adolescent group (5% vs. 6%, p = 0.018). Further analysis comparison between early and late adolescents revealed that the first group had significantly more physician appointments (35% vs. 32%, p = 0.025), and required more than two pediatric specialties (22% vs. 21%, p = 0.047). Likewise, the frequencies of emergency service visits (19% vs. 14%, p < 0.001) and hospitalizations (12% vs. 10%, p = 0.035) were higher in early adolescents. Conclusions: This study evaluated a large population in a Latin American hospital and suggested that early adolescents with chronic diseases required many appointments, multiple specialties and hospital admissions. Resumo: Objetivo: Descrever características de crianças e adolescentes com doenças crônicas de clínicas ambulatoriais em um hospital universitário terciário. Métodos: Um estudo transversal foi realizado com 16.237 pacientes com doenças crônicas acompanhados em um ano. Os dados foram coletados por meio de dados do sistema eletrônico de acordo com o número de consultas médicas em 23 especialidades pediátricas. Os pacientes foram divididos em dois grupos: crianças (0‐9 anos) e adolescentes (10‐19 anos). Também foram analisados grupos de jovens adolescentes (10‐14 anos) e adolescentes mais velhos (15‐19 anos). Resultados: 54% eram crianças e 46% eram adolescentes. As frequências das seguintes especialidades pediátricas foram significativamente maiores em adolescentes em comparação a crianças: cardiologia, endocrinologia, hematologia, nefrologia/transplante renal, neurologia, nutrologia, oncologia, cuidados paliativos e cuidado da dor, psiquiatria e reumatologia (p < 0,05). As frequências de visitas a serviços de emergência (30%, em comparação a 17%, p < 0,001), internações (23%, em comparação a 11%, p < 0,001), internações em unidade de terapia intensiva (6%, em comparação a 2%, p < 0,001) e óbitos (1%, em comparação a 0,6%, p = 0,002) foram significativamente menores em adolescentes do que em crianças. Contudo, o número de consultas médicas (≥ 13) por paciente (também) foi maior em grupos de adolescentes (5%, em comparação a 6%, p = 0,018). A comparação de análises adicionais entre jovens adolescentes e adolescentes mais velhos revelou que o primeiro grupo apresentou um número significativamente maior de consultas médicas (35%, em comparação a 32%, p = 0,025) e precisou de mais de duas especialidades pediátricas (22%, em comparação a 21%, p = 0,047). Da mesma forma, as frequências de visitas a serviços de emergência (19%, em comparação a 14%, p < 0,001) e internações (12%, em comparação a 10%, p = 0,035) foram maiores em jovens adolescentes. Conclusões: Este estudo avaliou uma grande população em um hospital da América Latina e sugeriu que jovens adolescentes com doenças crônicas precisaram de muitas consultas, diversas especialidades e internações hospitalares. Keywords: Adolescents, Chronic diseases, Emergency department, Hospitalization, Palavras‐chave: Adolescentes, Doenças crônicas, Departamento de emergência, Internaçã